Pancreatitis is a serious medical condition involving an inflammation of the pancreas. In acute or chronic pancreatitis the inflammation manifests itself in the release and activation of pancreatic enzymes within the organ itself, leading to autodigestion. In many cases of acute pancreatitis, the condition can lead to death.
In normal mammals, the pancreas, a large gland similar in structure to the salivary gland, is responsible for the production and secretion of digestive enzymes, which digest ingested food, and bicarbonate for the neutralization of the acidic chyme produced in the stomach. The pancreas contains acinar cells, responsible for enzyme production, and ductal cells, which secrete large amounts of sodium bicarbonate solution. The combined secretion product is termed “pancreatic juice”; this liquid flows through the pancreatic duct past the sphincter of Oddi into the duodenum. The secretion of pancreatic juice is stimulated by the presence of chyme in the upper portions of the small intestine, and the precise composition of pancreatic juice appears to be influenced by the types of compounds (carbohydrate, lipid, protein, and/or nucleic acid) in the chyme.
The constituents of pancreatic juice includes proteases (trypsin, chymotrypsin, carboxypolypeptidase), nucleases (RNAse and DNAse), pancreatic amylase, and lipases (pancreatic lipase, cholesterol esterase and phospholipase). Many of these enzymes, including the proteases, are initially synthesized by the acinar cells in an inactive form as zymogens: thus trypsin is synthesized as trypsinogen, chymotrypsin as chymotypsinogen, and carboxypolypeptidase as procarboxypolypeptidase. These enzymes are activated according to a cascade, wherein, in the first step, trypsin is activated through proteolytic cleavage by the enzyme enterokinase. Trypsinogen can also be autoactivated by trypsin; thus one activation has begun, the activation process can proceed rapidly. Trypsin, in turn, activates both chymotypsinogen and procarboxypolypeptidase to form their active protease counterparts.
The enzymes are normally activated only when they enter the intestinal mucosa in order to prevent autodigestion of the pancreas. In order to prevent premature activation, the acinar cells also co-secrete a trypsin inhibitor that normally prevents activation of the proteolytic enzymes within the secretory cells and in the ducts of the pancreas. Inhibition of trypsin activity also prevents activation of the other proteases.
Pancreatitis can occur when an excess amount of trypsin saturates the supply of trypsin inhibitor. This, in turn, can be caused by underproduction of trypsin inhibitor, or the overabundance of trypsin within the cells or ducts of the pancreas. In the latter case, pancreatic trauma or blockage of a duct can lead to localized overabundance of trypsin; under acute conditions large amounts of pancreatic zymogen secretion can pool in the damaged areas of the pancreas. If even a small amount of free trypsin is available activation of all the zymogenic proteases rapidly occurs, and can lead to digestion of the pancreas (acute pancreatitis) and in particularly severe cases to the patient's death.
Pancreatic secretion is normally regulated by both hormonal and nervous mechanisms. When the gastric phase of stomach secretion occurs, parasympathetic nerve impulses are relayed to the pancreas, which initially results in acetylcholine release, followed by secretion of enzymes into the pancreatic acini for temporary storage.
When acid chyme thereafter enters the small intestine, the mucosal cells of the upper intestine release a hormone called secretin. In humans, secretin is a 27 amino acid (3400 Dalton) polypeptide initially produced as the inactive form prosecretin, which is then activated by proteolytic cleavage. Secretin is then absorbed into the blood. Secretin causes the pancreas to secrete large quantities of a fluid containing bicarbonate ion. Secretin does not stimulate the acinar cells, which produce the digestive enzymes. The bicarbonate fluid serves to neutralize the chyme and to provide a slightly alkaline optimal environment for the enzymes.
Another peptide hormone, cholecystokinin (CCK) is released by the mucosal cells in response to the presence of food in the upper intestine. As described in further detail below, human CCK is synthesized as a protoprotein of 115 amino acids. Active CCK forms are quickly taken into the blood through the digestive tract, and normally stimulate the secretion of enzymes by the acinar cells. However, stimulation of the CCK receptor by the CCK analogs cerulein and CCK-octapeptide (CCK-8) appears to lead to a worsening of morbidity and mortality in mammals in whom pancreatitis is induced. See Tani et al., Pancreas 5:284-290 (1990).
As indicated above, the digestive enzymes are synthesized as zymogens; proto-enzyme synthesis occurs in the rough endoplasmic reticulum of the acinar cells. The zymogens are then packaged within vesicles having a single lipid bilayer membrane. The zymogens are packed within the vesicles so densely that they appear as quasi-crystalline structures when observed under light microscopy and the zymogen granules are electron-dense when observed under the electron microscope. The vesicles are localized within the cytoplasm of the acinar cells. Secretion of zymogens by the acinar cells occurs through vesicle docking and subsequent fusion with the plasma membrane, resulting in the liberation of the contents into the extracellular milieu.
Nerve cells appear to secrete neurotransmitters and other intercellular signaling factors through a mechanism of membrane fusion that is shared with other cell types, see e.g., Rizo & Sudhof, Nature Struct. Biol. 5:839-842 (October 1998), hereby incorporated by reference herein, including the pancreatic acinar cells.
Although the Applicants do not wish to be bound by theory, it is believed that a vesicle first contacts the intracellular surface of the cellular membrane in a reaction called docking. Following the docking step the membrane fuses with and becomes part of the plasma membrane through a series of steps that currently remain relatively uncharacterized, but which clearly involve certain vesicle and membrane-associated proteins, as has been illustrated using neural models.
In neurons, neurotransmitters are packaged within synaptic vesicles, formed within the cytoplasm, then transported to the inner plasma membrane where the vesicles dock and fuse with the plasma membrane. Recent studies of nerve cells employing clostridial neurotoxins as probes of membrane fusion have revealed that fusion of synaptic vesicles with the cell membrane in nerve cells depends upon the presence of specific proteins that are associated with either the vesicle or the target membrane. See id. These proteins have been termed SNAREs. As discussed in further detail below, a protein alternatively termed synaptobrevin or VAMP (vesicle-associated membrane protein) is a vesicle-associated SNARE (v-SNARE). There are at least two isoforms of synaptobrevin; these two isoforms are differentially expressed in the mammalian central nervous system, and are selectively associated with synaptic vesicles in neurons and secretory organelles in neuroendocrine cells. The target membrane-associated SNAREs (t-SNARES) include syntaxin and SNAP-25. Following docking, the VAMP protein forms a core complex with syntaxin and SNAP-25; the formation of the core complex appears to be an essential step to membrane fusion. See Rizo & Sudhof, id. and Neimmann et al., Trends in Cell Biol. 4:179-185 (May 1994), hereby incorporated by referenced herein.
Recently evidence has increasingly indicated that the SNARE system first identified in neural cells is a general model for membrane fusion in eukaryotic cells. A yeast exocytotic core complex similar to that of the synaptic vesicles of mammalian neural cells has been characterized, and found to contain three proteins: Sso 1 (syntaxin 1 homolog), SncI (synaptobrevin homolog), and sec9 (SNAP-25 homolog). Rizo & Sudhof, id. These proteins share a high degree of amino acid sequence homology with their mammalian synaptosomal counterparts.
All mammalian non-neuronal cells appear to contain cellubrevin, a synaptobrevin analog—this protein is involved in the intracellular transport of vesicles, and is cleaved by TeTx, BoNT/E, BoNT/F, and BoNT/G. Homologs of syntaxin have been identified in yeast (e.g., sso1p and sso2p) and mammalian non-neuronal cells (syn2p, syn3p, syn4p and syn5p). Finally, as indicated above, a yeast SNAP-25 homolog, sec9 has been identified; this protein appears to essential for vesicle fusion with the plasma membrane.
Intoxication of neural cells by clostridial neurotoxins exploits specific characteristics of the SNARE proteins. These neurotoxins, most commonly found expressed in Clostridium botulinum and Clostridium tetanus, are highly potent and specific poisons of neural cells. These Gram positive bacteria secrete two related but distinct toxins, each comprising two disulfide-linked amino acid chains: a light chain (L) of about 50 KDa and a heavy chain (H) of about 100 KDa, which are wholly responsible for the symptoms of botulism and tetanus, respectively.
The tetanus and botulinum toxins are among the most lethal substances known to man; both toxins function by inhibiting neurotransmitter release in affected neurons. The tetanus neurotoxin (TeNT) acts mainly in the central nervous system, while botulinum neurotoxin (BONT) acts at the neuromuscular junction; both toxins inhibit acetylcholine release from the nerve terminal of the affected neuron into the synapse, resulting in paralysis or reduced target organ function.
The tetanus neurotoxin (TeNT) is known to exist in one immunologically distinct type; the botulinum neurotoxins (BONT) are known to occur in seven different immunologically distinct serotypes, termed BoNT/A through BoNT/G. While all of these latter types are produced by isolates of C. botulinum, two other species, C. baratii and C. butyricum also produce toxins similar to /F and /E, respectively. See e.g., Coffield et al., The Site and Mechanism of Action of Botulinum Neurotoxin in Therapy with Botulinum Toxin 3-13 (Jankovic J. & Hallett M. eds. 1994), the disclosure of which is incorporated herein by reference.
Regardless of type, the molecular mechanism of intoxication appears to be similar. In the first step of the process, the toxin binds to the presynaptic membrane of the target neuron through a specific interaction between the heavy chain and a neuronal cell surface receptor; the receptor is thought to be different for each type of botulinum toxin and for TeNT. The carboxy terminal (C-terminal) half of the heavy chain is required for targeting of the toxin to the cell surface. The cell surface receptors, while not yet conclusively identified, appear to be distinct for each neurotoxin serotype.
In the second step, the toxin crosses the plasma membrane of the poisoned cell. The toxin is first engulfed by the cell through receptor-mediated endocytosis, and an endosome containing the toxin is formed. The toxin (or light chain thereof) then escapes the endosome into the cytoplasm of the cell. This last step is thought to be mediated by the amino terminal (N-terminal) half of the heavy chain, which triggers a conformational change of the toxin in response to a pH of about 5.5 or lower. Endosomes are known to possess a proton pump that decreases intra-endosomal pH. The conformational shift exposes hydrophobic residues in the toxin, which permits the toxin to embed itself in the endosomal membrane. The toxin then translocates through the endosomal membrane into the cytosol.
Either during or after translocation the disulfide bond joining the heavy and light chain is reduced, and the light chain is released into the cytoplasm. The entire toxic activity of botulinum and tetanus toxins is contained in the light chain of the holotoxin; the light chain is a zinc (Zn++) endopeptidase which selectively cleaves the SNARE proteins essential for recognition and docking of neurotransmitter-containing vesicles with the cytoplasmic surface of the plasma membrane, and fusion of the vesicles with the plasma membrane. The light chain of TxNT, BoNT/B, BoNT/D, BoNT/F, and BoNT/G cause specific proteolysis of VAMP, an integral protein. During proteolysis, most of the VAMP present at the cytosolic surface of the synaptic vesicle is inactivated as a result of any one of these cleavage events. Each toxin cleaves a different specific peptide bond.
BoNT/A and /E selectively cleave the plasma membrane-associated SNARE protein SNAP-25; this protein is bound to and present on the cytoplasmic surface of the plasma membrane. BoNT/C1 cleaves syntaxin, which exists as an integral protein having most of its mass exposed to the cytosol. Syntaxin interacts with the calcium channels at presynaptic terminal active zones. See Tonello et al., Tetanus and Botulism Neurotoxins in Intracellular Protein Catabolism 251-260 (Suzuki K & Bond J. eds. 1996), the disclosure of which is incorporated by reference as part of this specification. Bo/NTC1 also appears to cleave SNAP-25.
Both TeNT and BONT are specifically taken up by cells present at the neuromuscular junction. BONT remains within peripheral neurons and, as indicated above, blocks release of the neurotransmitter acetylcholine from these cells.
By contrast TeNT, through its receptor, enters vesicles that move in a retrograde manner along the axon to the soma, and is discharged into the intersynaptic space between motor neurons and the inhibitory neurons of the spinal cord. At this point, TeNT binds receptors of the inhibitory neurons, is again internalized, and the light chain enters the cytosol to block the release of the inhibitory neurotransmitters 4-aminobutyric acid (GABA) and glycine from these cells. Id.
International Patent Publication No. WO 96/33273 relates to derivatives of botulinum toxin designed to prevent neurotransmitter release from sensory afferent neurons to treat chronic pain. Such derivatives are targeted to nociceptive neurons using a targeting moiety that binds to a binding site of the surface of the neuron.
International Patent Publication No. 98/07864 discusses the production of recombinant toxin fragments that have domains that enable the polypeptide to translocate into a target cell or which increase the solubility of the polypeptide, or both.